Diagnosis
Smear test: Everything you need to know before your appointment
Article produced in association with Spital Clinic
Cervical screening saves thousands of lives from cervical cancer in the UK every year.
The programme has changed significantly in recent years, and understanding what it now involves — and what your results actually mean — is probably the most useful preparation you can do before your appointment.
Why Cervical Screening Exists — and What Changed in 2025
The NHS cervical screening programme now uses HPV primary screening — a method NHS England describes as testing for the human papillomavirus (HPV) rather than looking directly for abnormal cells.
If HPV is not found, the sample is not examined further; if HPV is found, the same sample is then checked for cell changes.
The reason HPV sits at the centre of this approach is straightforward. Nearly all cervical cancers are caused by certain high-risk types of HPV — and HPV is extremely common.
Most people encounter some form of it during their lives, and the body usually clears it without any treatment.
The problem arises when high-risk HPV persists, because over time it can cause cell changes in the cervix that, if left undetected, may eventually develop into cancer.
Cervical screening is therefore a prevention test, not a cancer diagnosis. Its purpose is to find those cell changes early, when treatment is straightforward and effective.
A significant change took effect in England on 1 July 2025.
The screening interval for those aged 25–49 was extended from three years to five years, in line with the 50–64 age group — so everyone aged 25 to 64 in England is now invited every five years.
The interval in Northern Ireland currently differs; Cancer Research UK has current details.
Who Is Invited and How to Book
NHS England invites everyone with a cervix aged 25 to 64, with the first letter usually arriving a few months before a person’s 25th birthday.
Invitations are sent automatically and are linked to GP registration — the simplest way to make sure yours arrives is to be registered with a GP and keep your contact details up to date. If your invitation hasn’t come through, any GP surgery can arrange an appointment.
Trans men and non-binary people registered as female with their GP will receive invitations automatically.
Those registered as male will not — but can self-refer through the NHS cervical screening programme website or ask their GP to arrange a test.
People over 65 are not routinely invited but are not excluded.
Anyone who has never been screened, or whose most recent result was abnormal, can request screening through their GP or a clinic.
Appointments are most commonly offered at GP surgeries, carried out by a nurse or doctor.
For those who prefer a different setting, shorter waits, or an appointment outside NHS hours, a private smear test can be arranged through specialist gynaecology clinics, often within a few days.
What Happens at a Smear Test Appointment
The test itself takes less than five minutes, with the full appointment lasting around ten minutes.
Knowing what happens — step by step — removes most of the uncertainty that makes it feel more daunting than it actually is.
You undress from the waist down and lie on an examination table, knees bent and falling gently apart.
The nurse or doctor applies a little lubricant and gently inserts a small speculum, which is opened just enough to make the cervix visible.
A small, soft brush sweeps a cell sample from the surface of the cervix. The speculum is removed, and you get dressed.
That is the entirety of the test.
A little preparation helps both comfort and sample quality.
Avoid vaginal medicines, lubricants, and creams for at least two days beforehand, as residue can interfere with the results. Avoid scheduling during your period for the same reason.
Loose-fitting clothing — a skirt or wide-leg trousers — makes undressing and repositioning much easier.
If you are going through the menopause, vaginal dryness can make speculum insertion uncomfortable.
Cancer Research UK notes that using a short course of oestrogen cream or pessaries for around two weeks beforehand can help considerably — though stop two days before the appointment to avoid affecting the sample.
It is worth mentioning to your GP when you book.
Most people feel some pressure or mild discomfort, but it does not usually hurt.
If you find it painful, you can ask for a smaller speculum, insert it yourself, or try lying on your side — all are standard adjustments. Light spotting afterwards is normal and usually clears within a few hours. You can ask to stop at any point.
Understanding Your Results
The most common result — received by 87 in every 100 people screened — is HPV not found.
That means no high-risk HPV was detected, your risk of developing cervical cancer before the next screen is very low, and nothing further is needed until your next invitation arrives in five years.
The other results fall into two categories. Nine in every 100 people are told HPV was found, but no cell changes were detected.
This is not a cancer result and does not require immediate treatment — it means high-risk HPV is present and the cervix is being monitored.
The pathway is a repeat screen at one year; if HPV is still present, another repeat at two years. Only if it persists at that point is a colposcopy referral made.
Four in every 100 people receive an HPV-positive result alongside detected cell changes, and are referred directly for colposcopy.
That referral is not a diagnosis of cancer.
A colposcopy is a closer examination of the cervix, carried out in a clinic using a magnifying device, allowing a clinician to look in detail at any flagged cell changes.
Most people who attend colposcopy do not have cervical cancer — NHS England is clear on this. If a biopsy is taken or cells are removed, there is a small risk of bleeding and infection, both well-managed.
Those who prefer not to wait for an NHS appointment can access a private colposcopy at specialist clinics.
Results usually arrive by post or through the NHS App within two to six weeks. Samples are kept for ten years.
HPV can remain in the body for many years without symptoms, so a positive result says nothing about recent exposure or transmission history.
HPV, the Vaccine, and When to See a GP Without Waiting
Nearly all cases of cervical cancer are linked to high-risk HPV.
The virus spreads through skin-to-skin genital contact, vaginal, anal or oral sex, and sharing sex toys — it does not require penetrative sex to pass between people. The vast majority of people who carry it clear it naturally and will never know they had it.
The UK’s HPV vaccination programme, which began in 2008, has meaningfully reduced risk in younger age groups.
But vaccinated people still need to attend cervical screening — the vaccine does not protect against all high-risk HPV types. Vaccination and screening work together; one does not replace the other.
Cervical screening runs on a schedule, but some symptoms need attention straight away — do not wait for your routine invitation.
According to NHS England, these include unusual vaginal bleeding, bleeding after sex, bleeding during or after the menopause, heavier periods than usual, changes in vaginal discharge, pain during sex, or persistent lower back or pelvic pain.
These symptoms do not confirm anything, but they need investigating without delay.
Attending every invitation remains the single most important thing anyone in the eligible age group can do — and with the 2025 extension to five-year intervals, each appointment now covers a longer window than it once did.
The extension of the English screening interval to five years is backed by strong evidence about the accuracy of HPV primary screening.
Simply turning up remains, by some margin, the most protective thing anyone in the eligible age group can do.
This article is for informational purposes only and does not constitute medical advice. For personal health concerns, consult a qualified healthcare professional. Cervical screening eligibility and intervals may vary; refer to current NHS guidance or your GP for the most up-to-date information applicable to your circumstances. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
Menopause is often absent from women’s electronic health records, a study of nearly 396,000 women has found.
Researchers found menopause appeared almost seven times more often in participant surveys than in electronic health records (EHRs).
The findings suggest important reproductive health information, including age at menopause, may often be missing from health records used for research.
Audrey Hendricks, associate professor of bioinformatics at CU Anschutz and the study’s principal investigator, said: “Ultimately, we cannot study what we do not measure. We cannot treat what we do not know.
“Menopause has enormous implications for women’s health, but if we don’t consistently capture when menopause occurs and other important reproductive health information, we limit our ability to understand how this transition affects disease risk and health outcomes.”
Researchers at the University of Colorado Anschutz analysed data from women taking part in the National Institutes of Health’s All of Us Research Program.
They compared menopause information reported by participants in surveys with menopause diagnoses recorded in their electronic health records.
Around 193,000 menopause observations were identified in survey data, compared with approximately 28,000 diagnoses in EHR data.
Menopause was documented in electronic health records for only about 7 per cent of women in the dataset.
Nearly all participants with a menopause diagnosis recorded in their EHR also reported menopause in survey data. However, substantially fewer women had menopause documented in their health records.
Other important information was also frequently unavailable, including age at menopause, which researchers may use when examining links between menopause and chronic disease risk.
Menopause is a physiological transition that can affect cardiometabolic health and many other aspects of women’s health.
Researchers said relatively little is known about how factors including the timing and type of menopause influence health outcomes across diverse populations.
Large-scale programmes such as All of Us combine participant surveys, electronic health records and genomic data, but menopause-related research depends on relevant reproductive health information being available.
Missing menopause information can make it harder to investigate how the transition relates to health and disease.
The findings may also help researchers using All of Us data define menopause-related study populations, design studies and estimate how many participants are needed.
Hendricks said: “We have an enormous opportunity to use large-scale datasets to understand women’s health across the menopause transition and to identify who may be at greater risk for disease.
“But we need to make sure that the information researchers need is actually being collected.
“We must do a better job of capturing women’s health information, including reproductive health and measures related to menopause.”
Researchers said more complete and consistent collection of menopause and reproductive health information could help future studies examine factors such as age at menopause and their relationship with disease risk and health outcomes.
The FDA has granted accelerated approval to AstraZeneca drug Etcamah for certain adults with advanced breast cancer carrying an ESR1 mutation.
Etcamah, also known as camizestrant, was approved in combination with a CDK4/6 inhibitor, either abemaciclib, palbociclib or ribociclib.
The treatment is for adults with hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer when an estrogen receptor-1 (ESR1) mutation is detected during aromatase inhibitor and CDK4/6 inhibitor therapy using an FDA-authorised test.
ESR1 mutations are acquired resistance mutations that tumours may develop during treatment with aromatase inhibitors, a type of endocrine therapy commonly used as a front-line treatment for locally advanced or metastatic breast cancer.
Fewer than 5 per cent of patients have the mutation when HR-positive metastatic breast cancer is diagnosed, according to the FDA. After disease progression on an aromatase inhibitor, nearly 40 per cent have the mutation.
Acting FDA commissioner Kyle Diamantas said: “Women living with metastatic breast cancer face an uphill battle as their tumors continuously evolve to escape treatment.
“We owe them every weapon in our arsenal.
“Today’s approval delivers a win to these patients by granting them a targeted therapy designed specifically to overcome resistance, giving them more time before their disease progresses.”
The accelerated approval programme allows earlier approval of drugs that treat serious conditions and fill an unmet medical need based on surrogate or intermediate endpoints.
For Etcamah, approval was based on how long patients lived without their disease worsening, measured from when the resistance mutation was first detected in their blood.
The FDA said it has not yet been confirmed whether intervening when the mutation is detected, rather than waiting until disease progression is confirmed, results in a clinically meaningful benefit. Confirmatory studies are therefore required to verify and describe clinical benefit.
Angelo de Claro, director of the FDA’s Oncology Center of Excellence, said: “I commend both the FDA and the sponsor for their commitment to advancing cancer care and securing this accelerated approval.
“This marks the first FDA approval of a cancer therapy guided by the detection of a resistance mutation in circulating tumor DNA (ctDNA) before imaging tests show that the disease is progressing.
“But additional evidence is needed to confirm clinical benefit.”
Circulating tumour DNA, or ctDNA, consists of small pieces of tumour DNA released into the blood and can allow earlier molecular detection of resistance mutations.
The FDA also authorised the Guardant360 CDx assay as a companion diagnostic to identify patients with breast cancer who have ESR1 mutations for treatment with camizestrant.
Efficacy was assessed in a clinical trial comparing a switch to Etcamah plus a CDK4/6 inhibitor with continued treatment using an aromatase inhibitor plus a CDK4/6 inhibitor.
Estimated median progression-free survival was 16 months in the Etcamah group, compared with 9.2 months in the aromatase inhibitor group.
Etcamah’s prescribing information includes a boxed warning about the risk of irregular heart rhythm when taken with certain other medicines. It also includes warnings about an abnormally slow heart rate and potential harm to an unborn baby.
The FDA convened its Oncologic Drugs Advisory Committee for the application on 30 April 2026.
Four leading cardiovascular health groups have agreed new guidance for healthcare professionals assessing patients with suspected heart attacks.
Historically, some less common forms of heart attack, which evidence shows affect women far more than men, have been classified as less important, with treatment and care often worse as a result.
Experts said women had been receiving less effective treatments that did not always target the specific cause of their heart attack and could even make them more unwell.
The changes were announced in Munich on the opening day of the annual congress of the European Society of Cardiology (ESC).
Professor Bryan Williams, chief scientific and medical officer of the British Heart Foundation, said: “This is a landmark moment, a radical shift in how we define and diagnose heart attacks worldwide which will transform people’s care.
“For decades, women have missed out on accurate diagnoses and treatment.
“This focus on finding less common causes of heart attacks, which predominantly affect women, should help to change that. It could be life-changing for huge numbers of women in the UK and worldwide.”
The new guidance upgrades three types of heart attack that can be up to 10 times more common in women and are often caused by childbirth, exercise and emotional stress.
The most serious cases, previously known as “type 1” and now classed as “primary” heart attacks, had previously prioritised those caused by a clot blocking blood flow to the heart.
Other forms can involve reduced blood flow for different reasons, including the tightening or tearing of coronary arteries. These can be more likely to be missed or treated less urgently.
The guidance also introduces a lower diagnostic threshold for women based on levels of troponin, a protein released into the blood when the heart is injured and damaged.
Previously, women were expected to meet the same troponin threshold as men to receive a diagnosis.
Williams said the streamlined heart attack categories would also help patients understand the cause of their heart attack and what comes next.
The three upgraded types are coronary artery spasm, coronary embolism and spontaneous coronary artery dissection (SCAD).
Coronary artery spasm involves the tightening of an artery, which can deprive the heart muscle of blood and oxygen. It can be caused by emotional stress, exercise or extreme cold.
Coronary embolism occurs when a blood clot or fatty deposit travels to a coronary artery and causes a blockage.
SCAD is caused by a tear in a coronary artery. Around 80 per cent of cases occur in women, and it often happens during or soon after pregnancy.
Professor Nicholas Mills, a cardiologist at the University of Edinburgh who led the international taskforce behind the guidance, said it was “the first time that we’ve had a truly global approach to aligning how we diagnose what is probably the most important diagnosis there is”.
He said: “It kills so many people, and we’ve never got everyone together around the world to agree how we’re going to describe it, classify it, explain it to our patients.
“Our job now is to implement this as widely as possible. It’s just as relevant for the UK as it is for any other country around the world. It is a revolution. It’s going to make care better for patients.”
Mills said there had been “unintended systematic bias against women”, including through the use of the key blood test for diagnosing heart attacks at an average level, which picks up all men but misses some women.
He said: “This is used for all types of heart attack in every emergency department in the world, and we want to make sure that it’s used correctly.”
The guidance was drawn up by the ESC, the American College of Cardiology, the American Heart Association and the World Heart Federation.
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